Linkages Between Community Mental Health Services, Homelessness, and Inmates and Probationers with Severe Mental Illness: An Evidence-Based Assessment

摘要

Closure of psychiatric hospitals in favor of community-based treatment methods (Torrey, 1997), resulted in jails and prisons becoming the “new asylums” of the United States (National Institute of Corrections, 2014). Over the past decade, research teams in Charlottesville, Virginia, have studied data from the region to better understand the nature and extent of the individuals in the criminal justice system who suffer from severe mental illnesses (Boland et al., 2019). The work presented here extends this prior research by enlarging the study population to cover a longer time period, by characterizing the dynamic paths individuals follow through various periods of incarceration, mental health services, homelessness, and probation/supervision, and by incorporating geocoding to explore whether proximity to treatment centers has an impact on linkage to mental health services.Under an approved Institutional Review Board (IRB) protocol, the research team partnered with multiple local criminal justice agencies and community service providers (CSPs) to share data. These agencies interact through the Albemarle-Charlottesville Evidence Based Decision Making (EBDM) Policy Team, where regular monthly meetings are held to discuss issues in the criminal justice system. The research team analyzed data across 48 months from July 2015 to June 2019. These data comprise 8,332 individuals booked into Albemarle/Charlottesville Regional Jail (ACRJ), 13,340 individuals who received Region Ten Community Services Board (R10) mental health or substance abuse services, 2,117 individuals in a locally maintained database of homeless individuals, and 4,345 individuals who received services from Offender Aid and Restoration (OAR), which supervises individuals on local probation. Of the individuals booked into ACRJ, 18 percent “screened in” for referral for mental health services according to the Brief Jail Mental Health Screener (BJMHS). Key findings and outcomes of this study include:•Of the 8,332 individuals booked into ACRJ, 5,499 individuals (67%;) were administered the BJMHS.•Of those 5,499 individuals administered the BJMHS, 1,534 screened in for referral to mental health services, which is 28%; of individuals who received the screener and 18%; of all individuals at ACRJ.These findings support the results of prior research with greater statistical confidence. New findings include:•Individuals who associate their current legal trouble with drugs and alcohol have a 12%; higher screening-in rate than those who do not.•63%; of individuals in ACRJ who screened in and were available to be treated once released ultimately were linked to R10 services.In previous years, BJMHS results showed that there were nearly three times as many people with severe mental illness in jail than previously estimated by the state, and that linkage to mental health services could be improved. These findings led to the development of the Therapeutic Docket, an alternative to the standard judicial process for individuals with severe mental illness (Jefferson Area Community Corrections, 2018). New findings continue to help members of the Thomas Jefferson Area Community Criminal Justice Board and the EBDM Policy Team gain insight into the needs of the region’s mentally ill inmate population, ultimately leading to more evidence-based decision-making regarding the treatment of these individuals within and beyond their periods of incarceration.